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Informational Brochures

Questions to ask before undergoing an in-office procedure

Increasingly, the Board of Registration receives inquiries about the safety of certain procedures to be performed in a physician's office instead of in a hospital. Each procedure has individual risks and benefits - there is no single answer.

As a service to the public, the Board's Clinical Care Staff created a list of questions that a patient should ask before agreeing to any procedure. These suggested questions are the product of the staff's experience analyzing consumer complaints and medical malpractice data.

This is not a list of every appropriate question, but these topics represent the type of information every patient should have before agreeing to a major medical procedure in a physician's office. These suggestions do not represent formal Board opinions or regulations.

Informed Consent

Prior to all procedures, the patient should have appropriate informed consent that includes the reason s/he is having the procedure, the alternatives to the procedure, the expected outcome, the associated risks, benefits and possible complications. Topics that might not be included in informed consent, but that the patient might discuss are the following:

Is this procedure of the type that is routinely performed in an office setting? (Obtaining a second opinion would be one way to check.)

What are the physician's credentials? Ideally, the physician should be Board certified in the specialty s/he is practicing. (Specialty Board Certification can be confirmed by on the Physician Profiles page.)

How many procedures of this type has the physician performed?

What is her/his complication rate? (Ask the physician whether there are any satisfied patients who would be willing to contact you.)

What is the physician's specialty training for this exact procedure? (It should be more than a weekend course.)

Hospital Privileges

There are many reasons that a patient may need to know about the physician's hospital privileges. This information can be confirmed by reviewing the Doctor's Profile.

Among the questions regarding hospital privileges are:

Does the physician have hospital privileges?

Do those privileges allow her/him to perform the same procedure in a hospital? (The answer should always be yes. Call the hospital's medical staff office to verify the physician's information.)

Has the physician performing the surgery insisted that you get general medical clearance for the procedure and for the sedation s/he is planning? (The answer should always be yes.)

Medications & Anesthesia

Patients should discuss all aspects of anesthesia and other medications with the physician before undergoing a medical procedure. Patients should make a complete list of prescription, non-prescription, and herbal substances taken on a regular basis, including dosage, and bring the list to the doctor to review and discuss.

What are the drugs that the physician plans to use during the procedure?

Will any of the drugs used - either at the site of the surgery or for sedation - react with any medications the patient is routinely taking? (It is important for patients to tell physicians all the medications they are taking, including aspirin, ibuprofen, acetaminophen, and herbal remedies.)

What type of anesthesia/sedation is planned?

What are the complications or side-effects of this anesthesia or sedation?

If the physician is going to use conscious sedation:

Who will be assisting the operating physician to monitor the patient during the procedure? Who is going to actually administer the anesthetic during the procedure? Has that person received formal training? (The physician cannot perform the procedure and adequately monitor the patient at the same time. The person monitoring the patient should be a licensed professional, such as a Registered Nurse, Physician Assistant, etc.)

What type of monitoring will be done during the procedure? (At a minimum, monitoring should include blood pressure, pulse, cardiac monitor, and oxygen saturation. All monitoring should be documented every 10 minutes.)

Emergency Plans

Even the best physician can have a problem with a procedure. The doctor and patient must discuss what procedures and resources are in place to respond to a possible emergency.

Questions to ask include:

What is the physician's plan in case of an emergency?

Where is the physician's emergency equipment located? When was it last checked? By whom?

When did the physician and her/his staff last undergo emergency certification and training? (ACLS {advanced cardiac life support} or equivalent.)

Who will monitor the patient after the procedure and where will the monitoring take place? What kind of emergency training does the post-procedure monitoring person have? (A patient who underwent conscious sedation should be monitored by a licensed person -- RN, LPN, PA -- for at least one hour after the procedure. Vital signs -- blood pressure, pulse, respirations, oxygen saturation -- should be monitored and recorded every 15 minutes for this period of time.)

After the Procedure

Even though the physician may have finished the procedure, there are still patient care issues to be resolved.

Questions to ask include:

If sedation is used, will the patient need a ride home?

What are the post procedure signs and symptoms that should be expected? What signs and symptoms are worrisome?

Who is the person that should be called about any problems after surgery.

If the person who will take the call is a nurse or physician's assistant, will the physician who performed the surgery be notified of a problem?

Will the physician who performed the procedure be available for emergencies?

If the problem requires an emergency room visit, will the physician who performed the procedure meet the patient there? Does the physician have privileges in the hospital where the patient is likely to go for an emergency?

If the patient is having a lesion (mole, lump, etc.) removed:

Will the tissue that is removed be sent to a pathology lab for biopsy? If not, why not?

How will the patient be notified of the results? Should s/he contact the physician, or should s/he wait for the physician to contact the patient with the results? How long a wait is anticipated?

What are the possible results from the biopsy and what could each one mean to the patient?

Other Issues

In general, unless the planned procedures are closely tied together, such as removal of multiple skin lesions, only one procedure should be performed on a single patient, especially in an office setting.

Does the physician have office policies regarding surgical procedures? (Ask to see them.)

If the patient is a pediatric patient, these questions should also include the following:

What is the physician's experience with pediatric patients?

What specialized pediatric training and experience does the person who is administering the anesthetic have?

Does the physician have pediatric emergency equipment and drugs available?

Are the surgeon and any assistants PALS (pediatric advanced life support) certified in pediatric emergencies? What is the date of the last certification?